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CMS Acting Director Pledges Flexibility with New Payment System Roll-Out

On Sept. 8, 2016, CMS Acting Administrator Andy Slavitt acknowledged the concerns expressed by the medical community and by lawmakers regarding the implementation timeline for the Medicare Access and CHIP Reauthorization Act (MACRA) and pledged that the final regulations will offer more flexibility for physicians.

MACRA, passed by Congress in 2015, repealed the Medicare sustainable growth rate physician payment formula and replaced it with a new payment system that represents a framework for rewarding providers for giving better care rather than more care. Physicians and other providers paid under the physician fee schedule can choose one of two paths to payment:

the Merit-Based Incentive Payment System (MIPS), or

participation in an alternative payment model (APM).

Fee schedule payments will be tied to this new system beginning in 2019, although the performance period starts next year.

Release of final MACRA regulations is expected this month. Because there will be little transition time for physicians between publication of final regulations and the 2017 performance year, Administrator Slavitt announced that for 2017, CMS will allow physicians to “pick their pace” for transitioning to the new payment system.

Physicians will be exempt from payment penalty in 2019 if they choose any one of the following three options:

Submit some MIPS information, including data from after January 1, 2017.

Submit MIPS information for a reduced number of days and potentially qualify for a small positive payment adjustment.

Submit information for a full calendar year and potentially quality for a modest positive payment adjustment.

Join an APM in 2017 and, if enough Medicare payments or patients through the APM, qualify for a 5 percent incentive payment in 2019.

In June, ASNC commented to CMS on its proposed rule for implementing MACRA and hosted a standing room-only session on MACRA at the ASNC Scientific Session in Boca Raton, FL. Speaking at the session, Cathie Biga, MSN, RN, president/CEO of Cardiovascular Management of Illinois, offered physicians tips for preparing for MACRA, including the importance of accessing and understanding their Quality and Resource Use Reports (QRURs), the data that underpin MIPS and APMs. Ms. Biga also encouraged physicians to choose the activities through which they will earn credit under the Clinical Practice Improvement Activities performance component of MIPS.